Dr Rachel Baggaley, head of Christian Aid's HIV Unit, writes from Barcelona on the opening days of the 14th United Nations AIDS summit. The most memorable image of the summit so far has been watching all but a handful of delegates get up and leave as an African woman took to the platform. Prior to this, they had listened intently to Dr Robert Sciliciano, an eminent scientist from Johns Hopkins University in the United States, explain why antiretroviral drugs alone cannot eliminate HIV. Milly Katana, a board member of the UN's Global Health Fund from Uganda, told the conference how rich country apathy and a failure to help Africa tackle poverty are the root causes of the HIV epidemic. But few were there to listen. The plenary sessions of the summit are taking place in a massive sports stadium. They consist of the usual menu of terrifying statistics, complex and exciting scientific advances and pleas from countries with high infection rates for more support. Having attended these conferences for more than ten years, I have often vowed never to go to one again. But I was pleasantly surprised at the start of this one when Peter Piot, the director of UNAIDS, challenged rich governments to keep their promise and provide ten billion dollars annually for the UN's Global Health Fund. This is how much UNAIDS says is necessary for a 'minimum credible response to the HIV epidemic'. He emphasised the need for both prevention and treatment, and called for Africa's crippling debt burden to be relieved. He also said there should be an end to donor-imposed limits on public sector spending, which severely restrict health and education services. And, of course, there was his call for hugely increased funding to tackle HIV. Although we have heard these messages before, this is the first time I can remember them coming in such strong terms from the United Nations. Money is always available for other priorities. High income countries spent more on agricultural subsidies in 2001, for instance, than the gross domestic product of all sub-Saharan African countries. On the opening day, the hope that vaccines might be available in five years rather than 10 hit the headlines. But all the experts I spoke to were no more optimistic than they had been a year ago. A colleague pointed out that this 'big story' was probably more the result of a lack of any real news here rather than a true scientific breakthrough. Besides, talk of vaccines is irrelevant for the 95 percent of the world's infected people who live in developing countries. Unless we adopt a dual approach - working on medical solutions and tackling poverty - we are never going to make any progress.
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